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DocuSign Envelope ID: F8416631-822D-444C-8COE-F530EA41841C <br /> HP 6229793 19615 COINSURANCE CONTRACT <br /> NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY PART B DECLARATION PAGE <br /> P.O.BOX 27427 RA L El GH.NORTH CAROL INA 27611-7427 HOMEOWNERS POLICY <br /> POLICY RENEWAL DECLARATION <br /> ....................................................... ....... . .......... <br /> ........... <br /> .......... .................. <br /> ............m MiAl -15 ............... .............................. <br /> BER u <br /> ........................................ ......................................... ............. <br /> HP 6229793 10/28/18 10/28/19 0916085 HO DECL 0913 0685730 <br /> ........................... .................................... ........... <br /> "NAMEOUNQU RFD.--;AN n ADDR ES.S.--.1111;1;1111--i ............................................... ................ <br /> ............................ -A--F............................ .................................. <br /> ................................................... <br /> DWIGHT E COMPTON SR. <br /> BETTY COMPTON <br /> 5900 COMPTON RD MATTHEW S DEITZ <br /> CEDAR GROVE, NC 27231-9353 TELE: (919) 732-7430 <br /> 110 MILLSTONE DR <br /> HILLSBOROUGH, NC 27278 <br /> TOTAL ANNUAL PREMIUM - - - - - - - - $1 ,004 <br /> FIRST MORTGAGEE - <br /> SECU <br /> PO BOX 25279 <br /> RALEIGH, NC 27611-5279 <br /> LN: 00897291 90 <br /> FORMS AND ENDORSEMENTS - HO-0002 05/11 , HO-3232 06112, HO-NC 08/13 , <br /> HO-PO32 06/12, HO-3246 05/03, HO-QR 08/15, HO-3220 06112, HO-0416 10/00, <br /> HO-2472 10/00 , HO-0490 05/11 , NO-0498 05/11 . <br /> OTHER POLICIES FOR MEMBERSHIP NUMBER 0916085: <br /> POLICY INSURED NAME <br /> AP 8176029 DWIGHT E COMPTON <br /> /22/18 <br /> -X- m - - -- -- -- --- --- -- <br /> 'P 6P AUTHORIZED RE SENTATIVE DATE <br /> ------------------- <br /> ... .............. <br /> ........... .............. ....................................... ............................................. .......... <br /> ............... --- - m ii -- k m. - .1............. <br /> ............. - - ;=............ .......... L.................. <br /> ................. ........... .................... .................................... ................... <br /> ............................................................... ........................ .............. ............... <br /> ........... ............................... .......... .......... <br /> .............................. ............ ................... .............. ................... <br /> ......................... ............ <br /> .................. ............... <br /> ............. <br /> .................... ...................... -------------...................... <br /> I=-------------------- ......-.-1=. . . <br /> ........................ <br /> ........... <br /> ........... ................ <br /> .... ............... <br /> .................. ui-- <br /> ................... ............... - -1 ........... ....... <br /> ----------- ........... .................. -... u. ;z;;=..................... -..... <br /> ............................uzu.11L, ;; u........... <br /> ..............- --- ...................... <br /> -g-D -; .................. ........................... <br /> ........... <br /> .................... ....................................... <br /> ......................... .................. <br /> ........................ ................. <br /> -- .................... <br /> . ......................... <br /> ............... i;u; ..............-. - - ; -=;'- _................... <br /> ............-1 L=..-- - <br /> ..........mull. ................. <br /> -h......................... ....................miil-;;. il- ' <br /> . ..... .....- ............ ............ <br /> ........... .......... <br /> -------------------------------............. <br /> ................... .............5.-F................... .. ... ...................... ME ........ ............................. <br /> ............ r;jtj F..''.- <br /> ................ T................................. <br /> . <br /> im.ianiz 1=.g.r............................................ ............................................. --------M----;-u.l .................................... i. r =-.. .............. - ............-....-..-.....-......-..................-......-...-........... <br /> ..m................ <br /> M.-.r.1 2i <br /> ..................................................... <br /> ... . ... . - <br /> -................. .. <br /> ... <br /> ............................Mmiiizi.. -;= <br /> - -I.,............ =.='...... <br />